Screening for atrial fibrillation: The essential role of GPs

Asymptomatic atrial fibrillation (AF) is associated with similar stroke risk as symptomatic AF, yet is often detected only after the patient presents with a devastating stroke. The first Australian guidelines for the screening and management of AF were released in 2018 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. This brief, practical summary of the guidelines focuses on screening in general practice

Reducing stroke risk in atrial fibrillation: Adherence to guidelines has improved, but patient persistence with anticoagulant therapy remains suboptimal.

Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians\u27 management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25–35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient\u27s factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician\u27s awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF

Atrial fibrillation:villain or bystander in vascular brain injury

Atrial fibrillation (AF) and stroke are inextricably connected, with classical Virchow pathophysiology explaining thromboembolism through blood stasis in the fibrillating left atrium. This conceptualization has been reinforced by the remarkable efficacy of oral anticoagulant (OAC) for stroke prevention in AF. A number of observations showing that the presence of AF is neither necessary nor sufficient for stroke, cast doubt on the causal role of AF as a villain in vascular brain injury (VBI). The requirement for additional risk factors before AF increases stroke risk; temporal disconnect of AF from a stroke in patients with no AF for months before stroke during continuous ECG monitoring but manifesting AF only after stroke; and increasing recognition of the role of atrial cardiomyopathy and atrial substrate in AF-related stroke, and also stroke without AF, have led to rethinking the pathogenetic model of cardioembolic stroke. This is quite separate from recognition that in AF, shared cardiovascular risk factors can lead both to non-embolic stroke, or emboli from the aorta and carotid arteries. Meanwhile, VBI is now expanded to include dementia and cognitive decline: research is required to see if reduced by OAC. A changed conceptual model with less focus on the arrhythmia, and more on atrial substrate/cardiomyopathy causing VBI both in the presence or absence of AF, is required to allow us to better prevent AF-related VBI. It could direct focus towards prevention of the atrial cardiomyopathy though much work is required to better define this entity before the balance between AF as villain or bystander can be determined

Establishing a Low-Cost Telecommunications Method to Provide Tele ENT Consultations From a Military Medical Center to Deployed Locations

In many deployed locations, access to expert medical advice can be limited. The expansion of telemedicine has bridged this gap; however, the large and costly technology required to perform telemedical activities hinders its accessibility. This study aimed to develop a low-cost telemedicine method in order to perform tele ENT consultations for deployed military personnel. The results indicated an ability to transmit clear endoscopic images between deployed and garrison locations using low weight/volume/cost laptop based telemedicine technology

D-Brane Potentials from Multi-Trace Deformations in AdS/CFT

It is known that certain AdS boundary conditions allow smooth initial data to evolve into a big crunch. To study this type of cosmological singularity, one can use the dual quantum field theory, where the non-standard boundary conditions are reflected by the presence of a multi-trace potential unbounded below. For specific AdS_4 and AdS_5 models, we provide a D-brane (or M-brane) interpretation of the unbounded potential. Using probe brane computations, we show that the AdS boundary conditions of interest cause spherical branes to be pushed to the boundary of AdS in finite time, and that the corresponding potential agrees with the multi-trace deformation of the dual field theory. Systems with expanding spherical D3-branes are related to big crunch supergravity solutions by a phenomenon similar to geometric transition.Comment: 26 pages, 3 figures, v4: a few typos fixed

Late-time Light Curves of Type II Supernovae: Physical Properties of SNe and Their Environment

We present BVRIJHK band photometry of 6 core-collapse supernovae, SNe 1999bw, 2002hh, 2003gd, 2004et, 2005cs, and 2006bc measured at late epochs (>2 yrs) based on Hubble Space Telescope (HST), Gemini north, and WIYN telescopes. We also show the JHK lightcurves of a supernova impostor SN 2008S up to day 575. Of our 43 HST observations in total, 36 observations are successful in detecting the light from the SNe alone and measuring magnitudes of all the targets. HST observations show a resolved scattered light echo around SN 2003gd at day 1520 and around SN 2002hh at day 1717. Our Gemini and WIYN observations detected SNe 2002hh and 2004et, as well. Combining our data with previously published data, we show VRIJHK-band lightcurves and estimate decline magnitude rates at each band in 4 different phases. Our prior work on these lightcurves and other data indicate that dust is forming in our targets from day ~300-400, supporting SN dust formation theory. In this paper we focus on other physical properties derived from the late time light curves. We estimate 56Ni masses for our targets (0.5-14 x 10^{-2} Msun) from the bolometric lightcurve of each for days ~150-300 using SN 1987A as a standard (7.5 x 10^{-2} Msun). The flattening or sometimes increasing fluxes in the late time light curves of SNe 2002hh, 2003gd, 2004et and 2006bc indicate the presence of light echos. We estimate the circumstellar hydrogen density of the material causing the light echo and find that SN 2002hh is surrounded by relatively dense materials (n(H) >400 cm^{-3}) and SNe 2003gd and 2004et have densities more typical of the interstellar medium (~1 cm^{-3}). The 56Ni mass appears well correlated with progenitor mass with a slope of 0.31 x 10^{-2}, supporting the previous work by Maeda et al. (2010), who focus on more massive Type II SNe. The dust mass does not appear to be correlated with progenitor mass.Comment: We corrected the 56Ni mass of SN2005cs and Figures 8 (a) and 8 (c

The puzzle of the formation of T8 dwarf Ross 458c

At the lowest masses, the distinction between brown dwarfs and giant exoplanets is often blurred and literature classifications rarely reflect the deuterium burning boundary. Atmospheric characterisation may reveal the extent to which planetary formation pathways contribute to the population of very-low mass brown dwarfs, by revealing if their abundance distributions differ from those of the local field population or, in the case of companions, their primary stars. The T8 dwarf Ross 458c is a possible planetary mass companion to a pair of M dwarfs, and previous work suggests that it is cloudy. We here present the results of the retrieval analysis of Ross 458c, using archival spectroscopic data in the 1.0 to 2.4 micron range. We test a cloud free model as well as a variety of cloudy models and find that the atmosphere of Ross 458c is best described by a cloudy model (strongly preferred). The CH4/H2O is higher than expected at 1.97 +0.13 -0.14. This value is challenging to understand in terms of equilibrium chemistry and plausible C/O ratios. Comparisons to thermochemical grid models suggest a C/O of ~ 1.35, if CH4 and H2O are quenched at 2000 K, requiring vigorous mixing. We find a [C/H] ratio of +0.18, which matches the metallicity of the primary system, suggesting that oxygen is missing from the atmosphere. Even with extreme mixing, the implied C/O is well beyond the typical stellar regime, suggesting a either non-stellar formation pathway, or the sequestration of substantial quantities of oxygen via hitherto unmodeled chemistry or condensation processes.Comment: 16 pages, 9 figure